The association of perceived social support, resilience, and posttraumatic stress symptoms among coronavirus disease patients in the United States

Background: Posttraumatic stress disorder (PTSD) has become a main psychological consequence of COVID-19. This study assessed the association between social support, psychological resilience, and probable COVID-19-related PTSD.

Methods: The PTSD Checklist for DSM-5, Medical Outcomes Study Social Support Survey, and Connor-Davidson Resilience Scale (CD-RISC) were used to assess for PTSD symptoms, social support, and resilience among COVID-19 patients treated at a large medical system in New York City between July 2020 and July 2023. Logistic regression evaluated the association between social support and resilience with PTSD. We further investigated whether associations differed across age, gender, site of acute care, vaccination status, and pre-existing mental disorders.

Results: Among the 1484 participants, 16.6 % had probable COVID-19-related PTSD. Higher scores on measures of resilience (OR: 0.68, 95 % CI: 0.61-0.75) and social support (OR: 0.96, 95 % CI: 0.93-0.99) were associated with lower odds of probable COVID-19-related PTSD. The association between resilience and PTSD was moderated by sex (p for interaction = 0.001), with resilience showing a stronger negative association with PTSD among men relative to women. Associations between resilience, social support, and COVID-19-related PTSD did not differ by age, sites of acute care, vaccination status, and pre-existing mental disorders.

Limitations: Cross-sectional design precludes establishing causal relationships; assessment timing was not considered; the short CD-RISC may limit measurement precision; single-center study may not be fully generalizable.

Conclusions: These findings suggest that individuals with low social support and resilience may be at higher risk of PTSD and should be screened and be the target of preventive interventions.